Unknown Individual – Optometrist, NPI 1417043415

Unknown Individual is a healthcare provider. based in Auburn, Massachusetts. specializing in Optometrist. They hold a License No. 2210 (MA). The NPI Number for Unknown Individual is 1417043415

Main info

Organization
Inactive
59 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1417043415
Phone
(508) 832-6277
Address
174 OXFORD STREET
Deactivation Date
30 January 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5088326277
Graduation Year
1967 (59 years ago)
PAC ID
9032306535
Professional Enrollment ID
I20101209000873
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 174, Oxford Street North, Stoneville, Auburn, Worcester County, Massachusetts, 01501, United States

    AUBURN, MA 015011529

    Phone: (508) 832-6277

    Fax: (508) 832-6277

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 01501)

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Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?
Yes — Unknown Individual has NPI 1417043415 on file in the registry.
Can Unknown Individual still bill if the NPI is inactive?
Do not rely on inactive status alone — contact the provider for confirmation.
What expertise is attributed to Unknown Individual?
Unknown Individual's specialty line reads Optometrist. Clinical services aligned with this taxonomy classification.
Where in Massachusetts is Unknown Individual registered?
Use Auburn, Massachusetts as the headline location for Unknown Individual here.
What does 2 location(s) imply?
2 practice locations appear in the available data.

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